Last Friday private healthcare company Circle announced
it was pulling out of its contract to run the Hinchingbrooke Hospital in
Cambridgeshire, blaming a £5million loss and an NHS crisis including “unprecedented increases in accident and emergency attendances,
insufficient care plans for patients awaiting discharge, and funding levels
that have not kept pace with demand".

True enough - but the real reasons for Circle’s snap exit emerged later that day, when the hospitals inspector the Care Quality Commission (CQC)
released its delayed report
into Circle’s management of Hinchingbrooke Hospital.

It was damning.

Hinchingbrooke - the flagship of NHS privatisation - was given the CQC’s worst ever rating for ‘caring’.
Both safety and leadership were also bottom of the heap. Circle’s cleverly branded ‘mutual’ model, far
from ‘liberating’
NHS professionals to make grassroots-led improvements, had in fact replicated some
of the worst hierarchical, bullying practices to be found in the NHS. And it
had lost the caring and expertise that are the NHS’s strengths, principally as
a result of poor leadership and financially-driven staff cuts to satisfy investors.

But Circle’s news management has always
been its forte (as David Cameron knows - his health advisor used to be a Circle
PR chief). By Friday afternoon, most journalists were packing up for the
weekend, Paris-sickened. Their pieces were already published, based on Circle’s pre-emptive morning statement, which suggested the only real difference between the private
Circle and the public NHS is how easily Circle can walk away from a hospital.

But that’s a long way from the full story.

Circle’s medical services were found to be delivering “poor
emotional and physical care which was not safe or caring…people were not
treated with dignity and respect… some patients were afraid of certain nursing
staff”’.

Some of the examples witnessed by the CQC in their two-day
inspection were chilling.

“We heard the staff member say to the patient ‘don’t
misbehave, you know what happens when you misbehave’. We later asked the
patient what they thought the staff member meant by this; the patient became withdrawn
and was unable to provide us with an answer.”

“A patient on Apple Tree Ward, who required support during
the night to go to the toilet told us that staff were ‘often too busy’. They
said ‘they tell me to go in my bed and they will change me when they have
time’.”

Other patients during the two-day inspection reported
similar experiences, or were witnessed being left dirty and distressed, and treated
rudely or roughly.

Inspectors found a patient with ‘challenging’ behaviour had
been sedated without any record of a proper assessment of their mental state or
best interest.

Circle’s junior doctors were often labelling patients “do
not resuscitate” without discussing the decision with patients or relatives, and
without any apparent oversight from senior doctors. Sometimes the failure to
discuss was because the patient lacked mental capacity, notes often suggested -
but the CQC “saw no evidence that a mental capacity assessment had been undertaken
in any of the patient records we looked at”.

The CQC notes “We found many instances of staff wishing to
care for patients in the best way, but unable to … prevent service demands from
severely impinging on the quality and kindness of care for patients.” It found Circle
lacking “sufficient appropriately skilled nursing staff”.

Though the details are shocking, the general picture is unsurprising to anyone except those who bought the
ideological hype about private sector magic dust. Circle won the contract by
promising what the Public Accounts Committee called an ‘unrealistic’ and
‘unprecedented’ level of savings - urged on by government officials. Circle’s
Full Business Case said it would achieve this by altering ‘nurse-patient
ratios’ but exactly how was blacked out of the plan when it was eventually
published. Leaks suggested plans to cut 320 posts in total.

Hinchingbrooke’s A&E department had over a quarter of
posts vacant. Staff were particularly worried that A&E facilities and staff
cover for children were unsafe, though some improvements have been made since
the inspection.

“Patients were routinely triaged within the waiting room
area with no consideration for their privacy and dignity…we saw patients getting
frustrated that they were waiting extended periods for treatment and lack of
information, however staff reported they wished they had more time to care.”

But the CQC discovered the hospital kept patients waiting
too long in ambulances before they
were allowed into A&E. And after
they were seen in A&E, they then waited far too long - up to 12 hours - to
be admitted to hospital. On this measure (so-called ‘trolley waits’) Hinchingbrooke
had one in 5 patients waiting between 4 and 12 hours, compared to a national average
of only one in 20 patients.

So much for key targets.

And whilst waiting in A&E, an unusually high number of
patients (double the national average) left before being seen, fed up of
waiting - and presumably unimpressed by the waiting-management computer system Circle
had boasted was modelled on the Argos tills. (Circle’s senior management team had
been hired from Argos,
Avon, Faberge, Tesco and fashion-website Asos, bragged Ali Parsa in an
article entitled “Government should not be running hospitals”).

There were pockets of good practice too. Maternity care and
outpatients and diagnostics were rated as good, and the chaplain singled out
for special praise.

But overall performance indicators are patchy at best - and
there are enough shocking examples for the overall rating of ‘inadequate’ to be
wholly justified.

Dangerously sloppy procedures were everywhere at privately-run
Hinchingbrooke, the inspectors found. Incomplete patient notes, missing care
plans, infected catheters, unwashed hands, broken clinical guidelines. Fluids
were repeatedly out of reach of patients despite the inspectors’ intervention. On
other wards, call bells were placed out of reach. Diabetic patients were left
without food. Patients missed vital medication rounds. Lifesaving resuscitation
equipment was not checked regularly. Many post-surgical patients were waiting over 30
minutes for a response to a call bell (Circle’s own figures claimed the maximum
wait was 8 minutes).

Many patients were being moved between wards in the middle
of the night. “One patient on the acute surgical and trauma ward said that they
had been on seven wards in the first three days of admission, and had been
moved at 12.45am, 3am and 5am on different days.”

The CQC was keen not to blame the permanent staff themselves
- though it did note an over-reliance on bank and agency staff (a problem Circle
repeatedly promised to fix) who were involved in many of the most worrying failings.
“All nursing staff told us the trust had
difficulty recruiting and retaining staff…one nurse told inspectors “we can’t
keep staff”.

Staff told the CQC that shortages also meant little time for
training. For example, “Staff at ward level were not competent in caring for
people at the end of their life, because they had not received the training
required to enable them to undertake this role.”

Of course there are similar incidents in NHS hospitals - all
are operating in a difficult environment as Circle themselves point out. But many
NHS hospitals are weathering the storm better than this experiment with
privatisation, sold as a way of ‘saving’ a District General hospital.

As for the claim that Circle was replacing an outdated
fixation on public ownership and ethos, with a supposedly more responsive,
grassroots approach, the CQC report comprehensively trounces that suggestion.

The CQC report says “teams were not engaged nor felt enabled
to raise concerns”. They found staff did not use Circle’s much trumpeted ‘stop
the line’ process supposed to help staff raise concerns about patient safety.
Staff said when they tried, “they were made to feel that they were to blame,
and they have done something wrong” - a feeling shared by the CQC inspectors who
witnessed this ‘blame approach’ when they ‘stopped the line’ themselves in
response to serious concerns.

Whilst a few senior doctors were well informed, “senior
nursing staff we spoke to said they did not feel involved in the
decision-making process within the hospital.” The findings will not surprise
those who have looked at other so-called “mutual” structures and found them of
greater benefit to higher paid, higher status staff.

All in all, the gulf between the privatisation rhetoric and
reality has never yawned wider.

The franchising model of privatisation is already dead. It’s
been shelved as a supposed ‘solution’ for other struggling smaller district
general hospitals like Weston and George Eliot.

But does that mean privatisation is dead?

No. Too many have staked their careers - and their fortunes - on it, for them to back off that easily.

No-one who understands the NHS has ever really expected the
private sector to make profits from running full service hospitals with A&E
departments.

But Parsa left at the end of 2012 for pastures new - his PR job done.
And with the Act secured, and former Vice President of US healthcare giant
United Health, Simon Stevens, now at the helm of the NHS, private health
companies see better profits (and less brand damage) than openly taking over full service
hospitals, as Circle’s statement on Friday hinted:

“We fully support the vision of
Simon Stevens’ (NHS England Chief Executive) 5-year Forward View, but these
potentially exciting reforms are too far into the future…if reform in the
region develops fast and a new role for us becomes clear, we are happy to play
our full part.”

In other words, if the entire NHS needs to be reconfigured
away from providing us with local hospitals towards easier, more profitable
routes for the private sector (perhaps a hefty chunk of ‘care in the community’),
well, bring it on.

All of this will help companies like Circle sort the
cherries from the potatoes.

And if the tariffs paid for many treatments are currently too low to squeeze a profit from, well, it's only a waiting game til the cherry picking undermines the NHS to the point the private sector providers can start flexing their muscles and demanding more money.

It's already starting.

In nearby Bedfordshire, Circle recently won a huge ‘integrated’
‘prime contractor’ contract for all musculo-skeletal services in the area - and
promptly tried to sub-contract
the undesirable bits back to the NHS on Circle’s own terms. As the local NHS
hospital told the BBC, “Our concern is that if we don't have the
planned work coming through, then with the way the NHS is financed, we don't
know whether we will have sufficient money to provide the emergency service.”
Recent reports suggest Bedford Hospital is now in severe financial
difficulties.

And Circle-style ‘mutual’ models are still being quietly pushed, as the
government encourages nine more hospital trusts to leave
the NHS - and makes clear that it
would like to see all of them follow - or perhaps just their profitable cherries, leaving the NHS with the underfunded spuds.

Authors note: We asked Circle for an interview for their side of the story, but they failed to respond.

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About the author

Caroline Molloy is co-editor of openDemocracy UK, editor of OurNHS, a journalist and speaker. She has been involved in many community campaigns, including successfully overturning the privatisation of 9 hospitals. Her particular interests include technology, services and the welfare state.

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